Capsular Contracture
Wondering what capsular contracture is? Well, it's a condition that may occur after breast augmentation surgery. When implants are placed under the breasts, the body forms a lining of living tissue around it as a natural response. This formation of capsule or scar tissue is a normal process. However, in some cases, this tissue tightens and squeezes the implant, which in severe cases, may result in the breast taking a distorted shape needing correction.
Understanding capsular contracture
Breast implant capsular contracture is a common condition and can occur in one or both the implanted breasts. Although, it can occur at any time, its probability is higher in the first few months after surgery. In the breast augmentation procedure, the breast implants are inserted in the pocket made for it under the breast. When the raw skin of the pocket starts to heal, it forms a capsule made of fibrous tissue around the implant. It's natural for this tissue to shrink a little, but in certain cases it can tighten the inserted implants to such an extent as to distort the appearance of the breast.
This shrinkage is assessed by Baker grading. The four grades of capsular contracture with capsular contracture symptoms are:
a. Grade I: This constitutes normal shrinkage, in which the breast looks natural and soft.
b. Grade II: In this stage the breast feels a little firm, but looks normal.
c. Grade III: This stage is a little severe, in which the breast becomes firm and looks abnormal. The shape of the breast may get a bit distorted.
d. Grade IV: This is a severe condition, in which the breast can take a 'ball-like' appearance becoming hard and painful. The breast looks positively abnormal.
However, the point to note is, it's not the implant that hardens, it's the squeezing and tightening of the tissue that makes the implant feel hard and firm. Once the implant is removed, it's as soft as ever.
Causes of capsular contracture
Why capsular contracture occurs in some and not in others is not clearly understood. The studies conducted by Institute of Medicine, involving both silicone gel-filled and saline-filled breast implants, showed capsular contracture rates of thirty-six to eighty-one percent for silicone-gel filled breast implants and eight to forty-one percent for saline-filled ones. Grade III and IV capsular contracture rates for saline implants showed nine percent occurrence in three years and ten to eleven percent in five years.
However, it's not the implants alone that may cause capsular contracture, certain other conditions too may put you at risk:
a. Subglandular placement: It's been observed that implants placed above the muscle make you more prone to capsular contracture, as compared to submuscular placement, where the implant is placed under the muscle.
b. Smoking: Smoking is considered bad here too! It decreases the oxygen levels in the blood, which may delay healing and lead to an inflammatory reaction, leading to shrinking of the tissue.
c. Infection: Body is more prone to capsular contracture after an infection. Even germ contamination or long-term bacterial contamination of implant shell can cause an inflammatory reaction, leading to shrinking.
d. Seroma: Seroma, the fluid accumulation around the implant, which may need to be surgically drained in order to permit proper healing, puts you at a higher risk.
e. Hematoma: Hematoma, the acumulation of blood requiring surgical intervention, can cause inflammatory reactions, leading to capsular contracture.
Correcting capsular contracture
Patients with grade III and IV capsular contracture require to be operated again. This may involve removal of the capsule tissue from around the implant by closed or open breast capsulotomy. In certain cases, even the implant itself has to be replaced. However, this procedure is no guarantee that this condition will not occur again.
Capsular contracture is a reality one has to face in breast augmentation surgery. But, it's certainly not such a big deterrent to make you avoid this surgery.
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